BACKGROUND INFORMATION: Most people encounter sleep
difficulties from time to time, often related to stress or pain. Many of
these bouts get better without treatment. Unfortunately, in a significant
proportion of the population, sleep problems turn into insomnia, which is
defined as the chronic inability to fall asleep or to enjoy uninterrupted
sleep. Some research suggests that attitudes about sleep, and the sleep
patterns and behaviors prompted by these attitudes, make certain
individuals vulnerable to chronic insomnia. The good news is that there is
a simple answer: vitamin D3, Calciferol, deficiency.

Just how
big a problem is insomnia? The National Sleep Foundation surveyed more
than a thousand adults in 2002. Thirty-five percent said that, every night
or almost every night of the previous year, they had at least one out of
these four symptoms: difficulty falling asleep, waking a lot during the
night, waking up too early and not being able to get back to sleep, or
waking up feeling un-refreshed. About 15 percent of the survey group
reported taking either a prescription sleep medication or an
over-the-counter sleep aid at least a few times a month. A study of the
Canadian population found that 24 percent of people ages 15 and older
reported insomnia, defined in this study as a "yes" response to the
question "Do you regularly have trouble going to sleep or staying asleep?"
Some of the factors associated with insomnia in this study included being
female, being widowed or single, having a low education level, low income,
unemployment, smoking, life stress, physical health problems, and pain or
activity limitation. Although age did not seem to be a factor in this
survey, other studies have shown that insomnia increases with age. For
example, 4 percent of a sample of older European adolescents met criteria
for insomnia disorder as defined by the Diagnostic and Statistical Manual,
4th edition (DSM-IV) of the American Psychiatric Association. Compare this
to a group of 330 elderly patients in a family practice, in which 57
percent met criteria for DSM-IIIR insomnia disorder. Whatís worse,
insomnia is not a benign problem. Difficulty falling asleep or staying
asleep is associated with an increased risk of dying in the elderly. Many
elderly insomniacs take naps during the day; in addition to making
insomnia worse, naps are related to higher mortality in this age group.
INSOMNIA INCREASES RISK OF DYING IN THE NEXT FIVE YEARS by 400%!

Although
many people believe that psychiatric disorders such as depression and
anxiety cause insomnia, the reverse may actually be true. The National
Institutes of Mental Health Epidemiologic Catchments Area study found the
risk of developing a new depression was 39.8times higher for
insomniacs than for those without sleep problems. Other research,
however, suggests that too little sleep--in particular too little rapid
eye movement (REM) sleep--can bring on a fibromyalgia muscle pain state.
This seems to be related to the drop of growth hormone, measured as
insulin-like growth factor-1 (IGF-1) seen in these fibromylagia-like
disorders.

Doctors are ignorant of the
simple facts of the biology of sleep. We are all animals that depend
on a wake-sleep cycle. This is called the circadian rhythm. This
rhythm is set up by our exposure to sunlight. There is more insomnia
when there is a lack of sunlight or darkness such as near the North pole.
We know that sunlight triggers the skin to form calciferol, commonly known
as Vitamin D3. The same hormone, yes, Vitamin D is a hormone, is
added to milk to insure that children get some hormone to help form long
bones and teeth. But Vitamin D3 does so much more. It has not been
recognized yet that Calciferol controls the release of melatonin and
regulates the pituitary release of growth hormone. You can imagine
what the lack of regular sleep-wakefulness does to any mammalian being. It
is extremely disruptive. Remember the movie INSOMNIA with Al Pacino and
Robin Williams?
It took less than one week for Pacino to be suicidal. Fortunately there is a
simple cure.

The simple diagnostic test is the Vitamin D 0,25 OH
test. Normal values are a range of 50 to 75. I regularly see
insomniacs with values of less than 20 even less than 10. And
because dark skinned individuals, African-Americans, Hispanics, middle
easterners, and those from the Indian continent need more sunlight, their
levels are typically lower.

And the simple treatment is take Vitamin D. The best
form is liquid and placed on the tongue at nighttime. I regularly
use 2000IU drop, two drops. There is no toxicity reported to those
taking less than 20,000 IU per day. But the appropriate follow-up
laboratory test every three months will show when a normal range is
reached.

Before discussing the additional amino acids and
minerals to assist good restful sleep, we must dismiss the 'experts' who
wish to blame the individual, not their lack of scientific understanding.

Some doctors state "it is
all in the individual's attitude! How wrong can they be! They state
"why would someone spend more time in bed than they actually need?
Attitudes towards sleep seem to be very important. Charles M. Morin and
colleagues at Virginia Commonwealth University found that insomniacs held
stronger beliefs than good sleepers about the detrimental consequences of
insomnia to physical and mental health, they made stronger attributions of
mood disturbances and lack of energy to poor sleep, and they perceived
their sleep as less controllable and predictable. Individuals with
sleep-onset insomnia (that is, difficulty falling asleep as opposed to
difficulty staying asleep) were more likely than those without insomnia to
focus on worries, problems, and noises in the environment prior to sleep,
and to think about not sleeping or about something that had happened
during the day. For instance, if you believe that you cannot function
adequately without having had a good nightís sleep, then even one night of
poor sleep may trigger behaviors such as staying in bed later or taking a
long nap. These behaviors are likely to make the insomnia chronic

So how much
sleep do you actually need? And how can you tell if you are getting the
right amount of sleep? Although eight hours per night is a figure repeated
so often that itís become an article of faith, the reality is that sleep
need is highly individual. Large-scale epidemiological studies have shown
that sleeping seven hours per night is associated with lowest mortality
risk compared to longer or shorter sleep. In addition, it is likely that
as we age, sleep need decreases.

On the
other hand, if you feel tired but canít fall asleep during the day, then
your tiredness is more likely fatigue instead of sleepiness. This is due
to adrenal exhaustion, lack of
DHEA and lack of
cortisol. Although many people, including researchers, use the terms
fatigue, tiredness, and sleepiness interchangeably, they are different
conditions. Most people can distinguish sleepiness or drowsiness such as
that felt after being up out of bed all night waiting in the emergency
room with a sick child, from the fatigue or weariness experienced after
running a marathon. Such "acute" fatigue is different yet again from the
"chronic" fatigue experienced by cancer patients, sufferers of chronic
fatigue syndrome or fibromyalgia. Chronic fatigue is experienced even
without exertion and does not improve with rest or sleep. One hypothesis
suggests that chronic fatigue, like depression, may be caused by too much
REM sleep. Experiencing this non-drowsy kind of tiredness together with
insomnia strongly suggests a person is getting more sleep than he or she
needs.

For worriers, the good news
is that all this cognitive-behavioral therapy is bull-sh-t. By measuring
Calciferol levels and replacing Vitamin D3 high dose oral drops, sleep
patterns will revert within a few days. We add 100- 200mg of 5-HTP (hydroxy-tryptophan)
to increase serotonin naturally. Another logical addition is 1000mg of
elementary magnesium or milk of magnesia. Magnesium helps relaxation of
the restless leg muscles and works to calm down overactive brain (cortex)
cells.

For depression, take
this same 5-HTP can be taken at 100mg dosages
throughout the day to assist in the treatment of depression. Depression
seems to respond directly to stabilization of the pineal gland (circadian
rhythm), adrenal and gonadal support, vitamin and mineral therapy. See
right column for 'pearls' to assist you in treatment. For
true chronic insomniacs that fail to respond, we add over-the-counter gabapentin 500mg 1-2 nightly for 5 out of 7 nights. Rarely does anyone not
sleep normally! This is fortunate for our patients, but unfortunate for the
pharmaceutical business that charges $4 per sleeper med.

For more information, seek
out the articles on
depression,
cortisol and
DHEA. Together, these non-pharmacological and natural treatments
for chronic insomnia are more effective and longer lasting than
any 'sleep' medications. If all else fails, I add Ataraxģ
(for hives). In dosages of 25-50mg, the relaxation effect works well
short-term!

Finally, the longer you are awake, the more exercise you get during the
day, the more slow-wave (delta) sleep you will have when you do sleep.
Slow-wave sleep is associated with feeling you have slept well, and with
feeling refreshed. To sleep well, then, get up early, but avoid going to
bed early. I canít express this any better than the following proverb,
which predates Benjamin Franklin by more that 200 years: "At
grammar-school I learned a verse, that is this, Sanat, sanctificat, et
ditat surgere mane." That is to say, "Early rising maketh a man whole in
body, holier in soul, and richer in goodliness." (Anthony Fitzherbert
(1470-1538): The Book of Husbandry, 1523).

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LICHTEN's PEARLS

Insomnia1. Measure Calciferol (Vitamin D3) 0,25 OH to determine lack of
appropriate sunlight-pineal function.2. Measure IGF-1 to
determine if the sleep-wake cycles are disrupting tissue repair. Low levels
of IGF-1, less than 160, are typical in fibromalygia and fatigue states.

Sex Hormones1. Menopause is
typical in women with insomnia. Measure the FSH and LH to show
hyper-secretion by the pituitary. LH triggers the hot flush and normal FSH
and LH are less tha 10mIU/ml. With addition of appropriate
estradiol, the FSH and LH will drop and the insomnia and hot flushes will
disappear.

2. For men, elevated FSH and LH
and low testosterone/SHBG are seen in andropause. Sleep disturbances
identical to the woman's hot flush with LH spikes can be seen. Again, by
replacement of the appropriate dosage of testosterone, the symptoms
of insomnia and sleep waking at 3-4 AM will often abruptly disappear.